The majority of our inmate patients are still fairly young. Many of the youthful inmate population spend available time in sports and bodybuilding activities. These individuals are prone to contracting exertional rhabdomyolysis (rhabdo). Correctional nurses need to be alert to the potential and respond effectively to stave off a disastrous outcome.
What Causes Exertional Rhabdomyolysis?
Rhabdo is the breakdown of muscle tissue causing an outpouring of intercellular contents including myoglobin, potassium, and creatine kinase (CK). These three elements cause the life-threatening effects of the condition. Non-traumatic rhabdo can be caused by severe over-exercise, major drug ingestion, or as a result of statin use. Many corrections-related incidents of rhabdo appear in the literature including 110 knee-bends performed as a part of an inmate hazing event, narcotic overdose and intravenous drug use.
Rhabdo can start innocuously and may be overlooked as delayed onset muscle soreness (DOMS) from over-exertion. However, if the overly sore muscles are accompanied by brown (coca-cola) urine or urine irregularities such as nocturia or anuria, beware. Further assessment is warranted.
A good history and assessment is necessary, including any unusual activities over the last 48 hours and a medication review. Many of our patient population are now on statins, which can complicate exertional rhabdo. If Rhabdo is suspected, labs for CK, potassium, and myoglobin should be drawn while monitoring urine output and cardiac rhythm. Under medical direction, fluids should be administered to assist the body to flush out the muscle breakdown byproducts. If not caught early enough, renal dialysis and/or cardiac interventions may be necessary.
Patient and Officer Education
One of the best nursing interventions for rhabdomyolysis is patient and officer education. Inmate bodybuilders should be aware that brown urine is a bad sign that should lead to a medical visit request. Officers should understand the adverse effects of hazing activities that might be a part of a particular inmate culture. Our aggressive and macho patient population can fall prey to competitive weightlifting challenges that go beyond rational sense, requiring intervention. Prevention or early treatment of rhabdo can avoid renal failure and life-threatening arrhythmias.
With awareness, education and vigilance, correctional nurses can reduce the chances of life-threatening results of rhabdomyolysis.
Have you experienced a rhabdo incident at your facility? Share your experience in the comments section of this post.
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